# MRS. TABETHA BROOME RENNER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1487810610
- **Gender:** F
- **Credential:** PA-AC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367H00000X | Anesthesiologist Assistant | 05414 | GA | Yes |
| 367H00000X | Anesthesiologist Assistant | — | — | — |

## Other

- **Enumeration date:** 08/07/2008
- **Last updated:** 04/13/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 578310 | WELLCARE | GA |
| 01 | — | 580628385 | TRICARE | GA |
| 05 | — | 606097755D | — | GA |
| 05 | — | 606097755E | — | GA |
| 05 | — | 606097755F | — | GA |
| 05 | — | 606097755G | — | GA |
| 01 | — | P01101055 | RAILROAD MEDICARE | GA |